Carcinoma in situ de mama en varon joven

Abstract

Introduction: Male breast cancer accounts for 1% of all breast cancers. Within this group, ductal carcinoma in situ (DCIS) represents 5% to 10%, making it an extremely rare entity. The median age of presentation is 60 years. Gynecomastia may coexist, although it is not considered a direct risk factor. However, the causal relationship with mutations in the BRCA 1 and 2 genes is well established. The most frequent clinical presentation is nipple discharge or a retroareolar mass. Histologically, the papillary subtype is the most common, with a high overexpression of hormone receptors (HR) and very infrequent HER2 positivity.
Clinical case: Male, 16 years old. Bilateral gynecomastia treated with liposuction. Pathology revealed low-grade DCIS of the right breast. Extensive loss of CK5 marker and almost 100% marking of HR, with no invasive component. Referred to a breast specialist, who performed bilateral mastectomy without sentinel lymph node biopsy. Final pathology: residual DCIS in the context of gynecomastia with associated atypical hyperplasia. No invasive neoplasia or stromal microinvasion.
Discussion: The presentation of DCIS in men occurs on average 5 years later than in women; its occurrence in young people and adolescents is infrequent. Given its low frequency, scientific evidence is limited and there are no specific management guidelines, so the approach is extrapolated from that used in adult male breast cancer. The standard treatment is total mastectomy. Axillary dissection is not indicated, as axillary invasion is exceptional. When the diagnosis is made by biopsy, the risk of underestimation is up to 26%. Endocrine or radiation may be applied to patients at higher risk of invasion. Disease-free survival rate exceeds 90% at 5 years. Local recurrence is infrequent and associated with conservative treatments.
Conclusions: Carcinoma in situ of the breast in men is a very rare entity, generally associated with a genetic mutation. Its treatment is mastectomy. Other therapies should be tailored to each individual case.